67Ga scintigram and MRI in malignant bone tumors and malignant soft tissue tumors]

We have analyzed the characteristics of 67Ga scintigram and MRI in 11 malignant bone tumors and 11 malignant soft tissue tumors. Osteosarcoma showed a high accumulation in 67Ga scintigram and low signal intensity in T1 weighted image. T2 weighted image were not characteristic. Chondrosarcoma showed medium 67Ga accumulation and low signal in T1 weighted image and high signal in T2 weighted image. Ewing sarcoma showed low accumulation in 67Ga scan and medium intensity in MRI. Malignant soft tissue tumors showed rather low 67Ga accumulation compared with malignant bone tumors. Malignant fibrous histiocytoma showed medium accumulation of 67Ga, low signal in T1 weighted image and high signal in T2 weighted image. Liposarcoma showed low 67Ga accumulation and medium signal in T1 weighted image and high signal in T2 weighted image. To summarize these characteristics, three dimensional display is demonstrated.     

Bone lymphoma: 67Ga scintigraphy and CT for prediction of outcome after treatment.

The purpose of the present study was to evaluate the role of 67Ga scintigraphy and CT in treatment monitoring of bone lymphoma. METHODS: Forty-four lymphoma patients with 91 sites of bone involvement were evaluated. Eight patients had Hodgkin's disease, and 36 patients had non-Hodgkin's lymphoma. Thirteen patients had primary lymphoma of the bone, and 31 patients had secondary lymphoma of the skeleton. 67Ga and CT studies were performed at baseline, during and at the end of treatment, and during follow-up. Positive 67Ga studies showed abnormal uptake in sites of lymphomatous involvement. Positive CT studies showed lesions with patterns of osteolysis, patterns of osteosclerosis, or a mixed pattern. A negative 67Ga or CT study showed disappearance of all lymphoma-related abnormalities. The sensitivity and specificity of 67Ga scintigraphy at presentation were calculated. Patterns of bone lymphoma on CT and their treatment-related changes were analyzed and recorded. Freedom-from-progression (FFP) curves were used to determine the prognostic value of positive and negative 67Ga and CT findings for predicting outcome after treatment. RESULTS: The sensitivity of 67Ga for diagnosis of bone lymphoma was 93%, and the specificity was 91%. A CT pattern of osteolysis was seen in 70% of skeletal disease sites at diagnosis and in 21% during follow-up. Osteosclerosis was present in 23% of sites at diagnosis and in 38% during follow-up. 67Ga findings became negative in 25% of patients during treatment, whereas only 1 patient showed negative CT findings. Forty-two percent of patients had negative 67Ga findings at the end of treatment, compared with 18% who had negative CT findings. Sixty-one percent of patients had negative 67Ga findings during follow-up, compared with 21% who had negative CT findings. A statistically significant difference in FFP was found between patients with positive and negative 67Ga findings at all evaluated time points. No statistically significant difference in FFP was found at any time point between patients with positive and negative CT findings. CONCLUSION: 67Ga scintigraphy has a high sensitivity and specificity for diagnosis of bone lymphoma. Bone lymphoma may show osteosclerotic and osteolytic CT patterns at diagnosis, during treatment, and after treatment. In most patients, CT studies do not become negative even 1 y after treatment. 67Ga scintigraphy, however, may be used as a predictor of long-term outcome in patients with lymphoma of the skeleton.     

Aggressive non-Hodgkin lymphoma: early prediction of outcome with 67Ga scintigraphy

PURPOSE: To evaluate use of gallium 67 scintigraphy early during chemotherapy to predict the outcome in patients with aggressive non-Hodgkin lymphoma. MATERIALS AND METHODS: Among 118 patients, 67Ga scintigraphy was performed after one cycle of chemotherapy in 51 patients, after a median of 3.5 cycles in 97 patients, and both in 30 patients. Computed tomography (CT) was performed after a median of 3.5 cycles of treatment in 87 patients. The failure-free survival was compared between patients with positive or negative 67Ga or CT scans by using the log-rank test. Multivariate analysis helped determine the relation between 67Ga scintigraphic and CT findings and the outcome. RESULTS: The differences in failure-free survival between patients with positive versus negative 67Ga scans after one cycle of treatment (P < .001) and at midtreatment (P < .001) were significant. There was no statistically significant difference in failure-free survival between patients with positive versus negative CT findings during treatment. In multivariate analysis, 67Ga scintigraphy after one cycle (P < .045) and at midtreatment (P < .006) was an independent factor associated with outcome. CONCLUSION: Gallium 67 scintigraphic findings after one cycle of chemotherapy and at midtreatment are predictive of outcome in patients with aggressive non-Hodgkin lymphoma. CT findings are not predictive. Early 67Ga scintigraphy during chemotherapy is a good indicator of patients who may benefit from a change to a more aggressive treatment. A future study is necessary to investigate the potential effect of early change of treatment.     

Usefulness of<Superscript>67</Superscript>Ga scintigraphy in extranodal malignant lymphoma patients

OBJECTIVE: 67Ga scintigraphy has a well-documented role in nodal lymphoma for both disease staging and assessment of treatment response. The objective of the present study was to examine the role of 67Ga scintigraphy in diagnosis and assessment of treatment response, in patients with extranodal malignant lymphoma. METHODS: Seventy-one patients with extranodal malignant lymphoma were studied. Whole body scans in all and SPECT scans in some selected patients were performed 72 hours after injection of 67Ga-citrate. The influence of tumor site, histological classification and tumor size on 67Ga scintigraphy sensitivity was analyzed. Twenty-one of the seventy-one patients also had a second 67Ga scintigraphy to assess response to treatment. RESULTS: The overall 67Ga scintigraphy sensitivity was 83.1% (59/71). The sensitivity was low in patients whose extranodal lymphoma occurred in skin (0/3) and urinary bladder (0/1), as compared to other tumor sites. According to the histological classification of the lesion, the sensitivity was lower in low-grade than in intermediate and high-grade lymphoma. According to the tumor size, the sensitivity was low in lesions less than 2 cm in diameter than those more than 2 cm in diameter. The results changed from positive to negative accumulation in 20 (95.2%) of the 21 patients who had 67Ga scintigraphy to assess the response to treatment. These 20 patients showed a good clinical course. CONCLUSIONS: Although 67Ga scintigraphy did not show positive accumulation in patients with skin and urinary bladder lymphoma, it was helpful to confirm the diagnosis and to evaluate the therapeutic effect in most patients with extranodal malignant lymphoma.     

Non Hodgkins lymphoma of the breast, unusual presentation: detection by 67Ga scintigraphy

Lymphomatous involvement of the breast is an uncommon cause of breast masses. A case is presented of a patient with bilateral breast involvement revealed by intense 67Ga uptake. Other foci of involvement were also detected scintigraphically, and confirmed by other imaging modalities. Multiagent chemotherapy resulted in significant clinical and scintigraphic regression of tumor, demonstrating the potential utility of 67Ga imaging in the follow-up of these patients.     

Non Hodgkins lymphoma of the breast,unusual presentation: Detection by 67Ga scintigraphy

Lymphomatous involvement of the breast is an uncommon cause of breast masses. A case is presented of a patient with bilateral breast involvement revealed by intense ⁶⁷Ga uptake. Other foci of involvement were also detected scintigraphically, and confirmed by other imaging modalities. Multiagent chemotherapy resulted in significant clinical and scintigraphic regression of tumor, demonstrating the potential utility of ⁶⁷Ga imaging in the followup of these patients.     

The role of gallium-67 citrate scintigraphy in gastro-intestinal malignant lymphoma

To evaluate the clinical usefulness of gallium-67 scintigraphy in the detection of the gastrointestinal (GI) non-Hodgkin's lymphoma (NHL) and in the assessment of the therapeutic effects, gallium-67 scintigraphy was reviewed on 24 cases (25 lesions; stomach in 20, ileum in 2, and terminal ileum and/or cecum in 3). Twenty-three out of the 25 lesions (92.0%) were detected by gallium-67 scintigraphy, while barium study could detect all of the 25 lesions. The sizes of the gallium-67 negative 2 lesions were the smallest of all (2.5 and 3.0 cm). The tumor size was considered to the most important factor in the detection by gallium-67 scintigraphy, while the histological classification and the location of the tumor were not related to its detectability. Findings in follow-up gallium-67 scintigraphy after therapy on 10 cases were correlated well with the therapeutic effects. These data suggest that gallium-67 scintigraphy is useful for the detection of GI involvement of NHL and for the assessment of therapeutic effects.     

Positive gallium-67 citrate scintigraphy in Wiskott-Aldrich syndrome with malignant lymphoma

This case describes the first detection of solid lymphoma lesions by gallium-67 scintigraphy in a 12-year-old patient with Wiskott-Aldrich syndrome. Gallium 67 uptake was found in multiple sites in the patient who had developed an undifferentiated small, noncleaved cell lymphoma. Response to chemotherapeutic treatment is correlated with findings on the gallium scintigraphy follow-up.     

67Ga scan for evaluating response to therapy in malignant lymphoma

67Ga scintigrams in a patient with malignant lymphoma before and after chemotherapy are presented. 67Ga did not accumulate in the mostly necrotic mass with some viable cells. Negative uptake of 67Ga might reflect necrosis of the tumor; however, it is difficult to detect some residual tumor cells. Therefore, negative uptake of 67Ga in the mass seen in X-ray CT may not be totally reliable evidence of eradication of viable tumor cells.     

67Ga scan for evaluating response to therapy in malignant lymphoma

⁶⁷Ga scintigrams in a patient with malignant lymphoma before and after chemotherapy are presented. ⁶⁷Ga did not accumulate in the mostly necrotic mass with some viable cells. Negative uptake of ⁶⁷Ga might reflect necrosis of the tumor; however, it is difficult to detect some residual tumor cells. Therefore, negative uptake of ⁶⁷Ga in the mass seen in X-ray CT may not be totally reliable evidence of eradication of viable tumor cells.     

Gallium-67 scintigraphy in an adult intussusception caused by malignant lymphoma

A rare case of adult intussusception caused by malignant lymphoma (ML) of the cecum was reported. In spite of the cecum lesion, strong⁶⁷Ga accumulation was located in the right epigastrium. This finding was useful in suggesting the presence of intussusception due to ML.     

Early 67Ga scintigraphy for the localization of abnominal abscesses.

Sixty patients suspected of having abdominal abscesses were evaluated by early and delayed 67Ga scintigraphy. The 67Ga scintigraphs obtained 6 hr after injection correctly localized 18 of 20 abdominal or retroperitoneal abscesses. An additional 13 patients with abnormal scintigraphs had clinically established infections. In no instance was an abscess or inflammatory focus present on delayed scintigraphs that was no evident on the 6-hr study. Two false-positive and two false-negative studies were recorded. Early 67Ga scintigraphy is warranted in patients with suspected abdominal abscesses.     

Thyroid scintigraphy and body scanning with 67 Ga in a case of primary thyroid lymphoma

The case of a 60-year old woman first presented a rapidly growing left cervical mass is presented. The fine needle aspiration-puncture (FNAP) lead to a diagnosis of thyroiditis. Due to the persistence of the symptoms, the FNAP was repeated again but was not conclusive, so that a surgical biopsy was performed. The pathological diagnosis was diffuse large cell primary thyroid lymphoma (PTL). The PTL is a rare entity that accounts for less than 1% of all the Non-Hodgkin's lymphomas. The thyroid scintigraphy showed the existence of a cold nodule in the left thyroid lobule and the 67Ga scan revealed a large abnormal lesion in the mediastinum that extended to the right latero-cervical region. After two chemotherapy courses, the 67Ga scan was normal.     

67Ga accumulation in inflammatory lesion and its mechanism: comparison with malignant tumor

The accumulation of 67Ga in inflammatory lesions increased with time after injection of turpentine oil and reached a plateau 5 days later. At that time the uptake in the lesions was larger than any other tissue, after ten days the lesion uptake decreased. In experiments using rats which had been kept for 5 days after subcutaneous injection of turpentine oil, the accumulation of 67Ga in inflammatory lesions increased with time until six days after administration of 67Ga-citrate. It is clear from this study that 67Ga is avidly accumulated in areas where the subcutaneous tissue is infiltrated with neutrophils and macrophages, that it is not accumulated at the sites in which neutrophils are crowded, that nuclear material, mitochondria, lysosomes and microsomes do not play a major role in 67Ga accumulation in the lesion and that the main binding acid mucopolysaccharide in the lesion is a acid mucopolysaccharide which is none of the following: keratan sulfate, heparan sulfate, heparin, or chondroitin sulfate A, B or C. It is presumed that the main 67Ga binding acid mucopolysaccharide is keratan polysulfate (or other oversulfated acid mucopolysaccharides).     

18FDG PET versus high-dose 67Ga scintigraphy for restaging and treatment follow-up of lymphoma patients

To date, only one published study has directly compared 67Ga scintigraphy (low dose, planar) with planar dual-head gamma camera 18F-fluorodeoxyglucose (18FDG) imaging for the purpose of treatment follow-up monitoring in lymphoma patients, and no data on restaging are available. The present study reports the direct comparison of high-dose (297-370 MBq) 67Ga planar and single photon emission computed tomography (SPECT) imaging and conventional 18FDG positron emission tomography (PET) for restaging and treatment follow-up of lymphoma patients versus a gold standard consisting of morphological imaging, including plain radiography and computed tomography (CT) scanning, bone marrow examination and long-term follow-up (<12 months). Sixteen patients, 10 with non-Hodgkin's lymphoma and six with Hodgkin's disease, were included (10 men, six women; median age, 43 years; range, 16-64 years). The median follow-up time was 27 months (range, 12-34 months). In two patients, 67Ga and 18FDG PET (370 MBq) were performed twice, resulting in 18 cross-sectional episodes. In 11 episodes, the results obtained by both imaging modalities were in agreement with regard to the presence or absence of disease when compared with the gold standard. However, the abnormalities found on 18FDG PET were always more extensive. In two episodes, 67Ga imaging normalized after treatment, whereas PET showed significant regression followed by subsequent normalization. In four additional episodes, 67Ga images were negative, whereas 18FDG PET visualized non-tumour-related pathology, such as lung infection, rib fracture or dense thymic tissue. In one gold standard-negative patient, the underlying cause of sternal FDG uptake remained undetermined. The data presented, although limited in number, suggest that 18FDG PET performs better than Ga imaging in monitoring lymphoma disease status. However, a correlation with clinical history and a knowledge of the characteristics of benign lesions are mandatory. Further studies are recommended.